3/5/2014 ICD-10: How to make the transition, part 1 Presented by Evan M. Gwilliam, MBA DC CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA Sponsored by 1 Dr. Evan Gwilliam • • Education • Bachelor’s of Science, Accounting - Brigham Young University • Master’s of Business Administration - Broadview University • Doctor of Chiropractic, Valedictorian - Palmer College of Chiropractic Certifications • Certified Professional Coder (CPC) - AAPC • Nationally Certified Insurance Coding Specialist (NCICS) - NCCT • Certified Chiropractic Professional Coder (CCPC) - AAPC • ChiroCode Certified Chiropractic Professional Coder (CCCPC) - ChiroCode • Certified Professional Coder – Instructor (CPC-I) - AAPC • Medical Compliance Specialist – Physician (MCS-P) - MCS • Certified Professional Medical Auditor (CPMA) – AAPC, NAMAS • Certified ICD-10 Trainer - AAPC 2 1 3/5/2014 Recommended Tools ChiroCode’s Complete and Easy ICD-10 Coding for Chiropractic Inside you will find: • Comprehensive list of relevant ICD10-CM codes for Chiropractic (~15,000 codes) • Tools to help you convert from ICD-9CM to ICD-10-CM o GEMs code map o Commonly used codes o Alphabetic index • Complete guide to understanding ICD-10-CM coding • Other aids you need for a painless transition. 3 Disclaimer Every attempt has been made to make this presentation as current as possible, but things change Be sure to check with your local carriers and Medicare for updates as the ICD-10 implementation date gets closer Subscribe to ChiroCode alerts for updates that pertain to DCs 4 2 3/5/2014 Why can’t we keep using ICD-9? ICD-9 ~14,000 codes ICD-10 ~68,000 codes 5 Will Oct. 1, 2014 be the end of the world? 6 3 3/5/2014 How are ICD-9 and ICD-10 similar? ICD-9 I. Official Guidelines (about 30 pages) II. Indexes i. Diseases and Injuries (300 pages) i. Neoplasms (20 pages) ii. Drugs and Chemicals (30 pages) iii. External Causes (20 pages) 7 How are ICD-9 and ICD-10 similar? ICD-10 I. Official Guidelines (about 30 pages) II. Indexes i. Diseases and Injuries (340 pages) ii. Neoplasms (20 pages) iii. Drugs and Chemicals (50 pages) iv. External Causes (35 pages) 8 4 3/5/2014 How are ICD-9 and ICD-10 similar? ICD-9 III. Tabular list (340 pages) 1. Infectious Diseases 2. Neoplasms 3. Endocrine 4. Blood 5. Mental 6. Nervous 7. Circulatory 8. Respiratory 9. Digestive 10. Genitourinary 11. Pregnancy 12. Skin 13. Musculoskeletal 14. Congenital malformations 15. Perinatal 16. Signs and Symptoms 17. Injuries and Poisoning E-codes. External Causes V-codes. Health Status 9 How are ICD-9 and ICD-10 similar? ICD-10 III. Tabular list (600 pages) 1. Infectious Diseases 2. Neoplasms 3. Blood 4. Endocrine 5. Mental 6. Nervous 7. Eye 8. Ear 9. Circulatory 10. Respiratory 11. Digestive 12. Skin 13. Musculoskeletal 14. Genitourinary 15. Pregnancy 16. Perinatal 17. Congenital malformations 18. Signs and Symptoms 19. Injuries and Poisoning 20. External Causes 21. Health Status 10 5 3/5/2014 How are ICD-9 and ICD-10 similar? Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00 – M99) • • • • • • • • M00 to M25, Arthropathies (diseases of the joints) M40 to M43, Dorsopathies (diseases of the spine) M45 to M49, Spondylopathies (diseases of the vertebrae) M50 to M54, Other Dorsopathies M60 to M63, Disorders of Muscles M65 to M67, Disorders of synovium and tendons M70 to M79, Other soft tissue disorders M80 to M94, Osteopathies and Chondropathies (diseases of bone and cartilage) • M99 Biomechanical Lesions, NEC (subluxations and others) Codes assigned to each chapter are broken into blocks of one or more 3 digit codes each. Each block deals with a specific disease and associated symptoms.11 How are ICD-9 and ICD-10 different? • The alphanumeric structure of ICD-10 allows for more specific information • Increased codes and categories allow for more accurate representation of the patient’s diagnoses 12 6 3/5/2014 How are ICD-9 and ICD-10 different? Feature ICD-9-CM ICD-10-CM Number of Codes About 14,000 About 68,000 Number of characters •3-5 characters in length •Characters are all numeric (or E or V) •3-7 characters in length •Character 1 is alpha •Character 2 is numeric •Characters 3-7 are alpha or numeric •Decimal is used after 3 characters •Some codes use “x” for characters 4-6 •Character 7 used in certain chapters •Decimal is used after 3 characters Number of chapters 17 chapters (plus E and V) 21 chapters 13 How are ICD-9 and ICD-10 different? Feature ICD-9-CM ICD-10-CM Start Date 1975, 1979 in US 1994, 2014 in US Expansion Very limited Has significant ability to expand without a structural change Detail Lacks detail Very specific Laterality Lacks laterality Includes laterality when appropriate Encounters Encounters are not defined Initial and subsequent encounters are defined Combination Codes Combination codes are limited Combination codes are frequent 14 7 3/5/2014 How are ICD-9 and ICD-10 different? ICD-9 ICD-10 15 What are some ICD-10 examples? ICD-10-CM code for chronic gout due to renal impairment, left shoulder, without tophus. Note: there are 11 gout codes in ICD-9 and 365 in ICD-10 16 8 3/5/2014 What are some ICD-10 examples? In ICD-9: E844.8 Sucked into a jet without damage to airplane; ground crew 17 What are some ICD-10 examples? In ICD-10: V97.29&A#g€: Sucked into a jet without damage to airplane; luggage cart driver; male; under 5’5” in height; slightly bald; wearing a tank top; during a full moon 18 9 3/5/2014 What are some ICD-10 examples? W61.43xA Pecked by a turkey, initial encounter 19 What are some ICD-10 examples? Migraines 44 choices available for migraines • Documentation must include: o o o o o o o With or without aura Intractable or not intractable With or without status migrainosus Persistent or chronic With or without vomiting With or without opthalmoplegic, menstrual, etc Induced by ICD-10 training G43.701 Chronic migraine without aura, not intractable, with status migrainosus 20 10 3/5/2014 What are some ICD-10 examples? Kissing Spine In ICD-10 (tabular list, page 217) In ICD-9 (alphabetic index) Kissing Osteophyte Spine Vertebra 721.5 721.5 721.5 Kissing Spine, unspecified Occipito-atlanto region Cervical region Cervicothoracic region Thoracic region Thoracolumbar region Lumbar region Lumbosacral region M48.20 M48.21 M48.22 M48.23 M48.24 M48.25 M48.26 M48.27 21 What are some ICD-10 examples? • M refers to "diseases of the musculoskeletal system and connective tissue." • After the letter are two characters, then a decimal, then more characters which add more specific information. • For example, the “21” in M21.752 refers to "other acquired deformities of limbs" • The “7” adds the detail of "unequal limb length." • The “5” tells us that it is at the femur • The “2” tells us that it is on the left 22 11 3/5/2014 M21.752 Unequal limb length (acquired), left femur 23 M21.752 Unequal limb length (acquired), left femur 24 12 3/5/2014 M21.752 Unequal limb length (acquired), left femur 25 M21.752 Unequal limb length (acquired), left femur 26 13 3/5/2014 M21.752 Unequal limb length (acquired), left femur 27 What are some ICD-10 examples? M21.752 Unequal limb length (acquired), left femur • “M” refers to "diseases of the musculoskeletal system and connective tissue." • “21” refers to "other acquired deformities of limbs" • The “7” adds the detail of "unequal limb length." • The “5” tells us that it is at the femur • The “2” tells us that it is on the left 28 14 3/5/2014 How do I find the ICD-10 code? How do I find the ICD-10 code? Three methods using the ChiroCode ICD-10 book: 1. Commonly used code list, pages 44-56 (but don’t stop there!) 2. GEMs code map, pages 57-133 (don’t stop here either!) 3. Alphabetic index, pages 455-472 (this is not safe either!) Always confirm the code using the tabular list (pages 135-454). 30 15 3/5/2014 1. Common Codes 31 1. Common Codes 32 16 3/5/2014 2. GEMs General Equivalence Mappings (GEMs) o Created by the National Center for Health Statistics, part of the CDC o Forward maps from ICD-9 to ICD-10 o Backward maps from ICD-10 to ICD-9 o Download the free tablet/smartphone app called “FindACode” o Use the Code Map section in the ChiroCode ICD-10 book (pages 57-133) o ChiroCode members can access the MapACode tool in their accounts 33 2. GEMs 34 17 3/5/2014 3. Alphabetic index 35 Example A 32 year old female presents with low back pain at L4/L5. The pain worsens with extension and with exercise. The patient complains of tight hamstrings and pain in the low back. An x-ray reveals a grade II spondylolisthesis at L4. On September 30, 2014, the diagnosis is 738.4 Acquired Spondylolisthesis. On October 1, 2014, it is: 36 18 3/5/2014 1. Common Codes 37 2. GEMs 38 19 3/5/2014 3. Alphabetic index 39 40 20 3/5/2014 Tabular List 41 Tabular List 42 21 3/5/2014 Example A 32 year old female presents with low back pain at L4/L5. The pain worsens with extension and with exercise. The patient complains of tight hamstrings and pain in the low back. An x-ray reveals a grade II spondylolisthesis at L4. On September 30, 2014, the diagnosis is 738.4 Acquired Spondylolisthesis. On October 1, 2014, it is: M43.16 Spondylolisthesis, lumbar region Note: Common codes gave two options GEMs was unspecified Alphabetic Index only gave the category 43 Recommended Tools ChiroCode’s Complete and Easy ICD-10 Coding for Chiropractic Go to ChiroCode.com, click on the ICD10 book and use: “DRG10” to get a $10 discount ICD-10: How to make the transition, part 2 will focus on minimizing revenue interruption. 44 22